中国血液净化

›› 2007, Vol. 6 ›› Issue (10): 545-547.

• 论著 • 上一篇    下一篇

CVVH疗法对全身炎症反应综合征及脓毒血症患者内皮功能损伤标志物的影响

薛 骏 刘骏峰 李铭新 施雪枫 丁 峰 陆福明 顾 勇 林善锬   

  1. 200040 上海，复旦大学附属华山医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-10-12 发布日期:2007-10-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-10-12 Published:2007-10-12

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摘要： 目的 初步探讨连续血液净化疗法CBP(continuous blood purification)对全身炎症反应综合症(SIRS)及脓毒血症(Sepsis)患者内皮功能损伤标志物的影响。方法 选择复旦大学附属华山医院肾内科15例SIRS或伴Sepsis患者，分别留取CVVH(continuous venous-venous homofiltrtion, 连续静脉静脉血液滤过)治疗前后的血浆，直接检测血栓调节蛋白(sTM，soluble thrombomodulin)、E－选择素、细胞间黏附分子-1(sICAM-1，soluble intercellular adhesion molecule-1)浓度。APACH II评分评价临床疗效。结果 临床转归：8名SIRS组患者，CVVH治疗后第4天APACH II评分较治疗前显著改善(P＜0.01)，而7名Sepsis组患者的APACH II评分更加恶化。SIRS组患者血浆sTM、sICAM-1、sE-选择素浓度显著高于正常对照组(P＜0.01)；Sepsis组患者血浆sTM、sICAM-1、sE-选择素浓度显著高于正常对照和SIRS组(P＜0.01)；CVVH治疗后1周，SIRS组患者sTM、sE-选择素较治疗前明显降低(P＜0.05),而Sepsis组患者无明显降低(P＞0.05)。结论 SIRS/Sepsis患者内皮细胞存在明显的激活和损伤，CVVH治疗能部分改善SIRS患者内皮细胞功能，而对Sepsis患者效果不佳。

关键词: 内皮细胞, 连续静脉静脉血液滤过, 血栓调节蛋白, 细胞黏附分子, E-选择素

Abstract:

Objective Efforts were made to investigate the effects of continuous venous-venous hemofiltration (CVVH) on the markers for endothelial injury in systemic inflammatory response syndrome and sepsis (SIRS/sepsis) patients. Methods Soluble thrombomodulin (sTM), soluble intercellular adhesion molecule-1 (sICAM-1), soluble E-selectin in plasma were measured by ELISA before and after CVVH treatment in 15 SIRS/sepsis patients. APACH II scores were used to evaluate the CVVH effects. Results APACH II scores improved on the 4th day after the treatment in 8 SIRS patients, but worsened in 7 sepsis patients. Plasma sTM, sICAM-1 and E-selectin were significantly higher in SIRS/sepsis patients than in normal controls, and were higher in sepsis patients than in SIRS patients. On the 7th after the treatment, plasma sTM and sE-selectin decreased remarkably in SIRS patients but not in sepsis patients. Conclusion Endothelial activation and injury occur in SIRS/sepsis patients. CVVH can partially improve the endothelial function in SIRS patients but not in sepsis patients.

Key words: Continuous venous-venous hemofiltration, Thrombomodulin, Intracellular adhesion molecule-1, E-selectin

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